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Clinical risk score...
Clinical risk scores identify more patients at risk for cardiovascular events within 30 days as compared to standard ACS risk criteria : the WESTCOR study
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- Steiro, Ole-Thomas (author)
- Haukeland Hosp, Dept Heart Dis, Bergen, Norway.
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- Tjora, Hilde L. (author)
- Haukeland Hosp, Emergency Care Clin, Bergen, Norway.
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- Langorgen, Jorund (author)
- Haukeland Hosp, Dept Heart Dis, Bergen, Norway.
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- Bjorneklett, Rune (author)
- Haukeland Hosp, Emergency Care Clin, Bergen, Norway.;Univ Bergen, Dept Clin Med, Bergen, Norway.
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- Nygård, Ottar K. (author)
- Haukeland Hosp, Dept Heart Dis, Bergen, Norway.;Univ Bergen, Dept Clin Med, Bergen, Norway.
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- Skadberg, Oyvind (author)
- Stavanger Univ Hosp, Lab Med Biochem, Stavanger, Norway.
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- Bonarjee, Vernon V. S. (author)
- Stavanger Univ Hosp, Dept Cardiol, Stavanger, Norway.
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- Lindahl, Bertil, 1957- (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- Omland, Torbjorn (author)
- Akershus Univ Hosp, Div Med, Oslo, Norway.;Univ Oslo, Fac Med, Ctr Heart Failure Res, Inst Clin Med, Oslo, Norway.
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- Vikenes, Kjell (author)
- Haukeland Hosp, Dept Heart Dis, Bergen, Norway.;Univ Bergen, Dept Clin Med, Bergen, Norway.
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- Aakre, Kristin M. (author)
- Univ Bergen, Dept Clin Med, Bergen, Norway.;Haukeland Hosp, Dept Med Biochem & Pharmacol, Jonas Lies Vei 65, N-5021 Bergen, Norway.
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Haukeland Hosp, Dept Heart Dis, Bergen, Norway Haukeland Hosp, Emergency Care Clin, Bergen, Norway. (creator_code:org_t)
- 2020-10-02
- 2021
- English.
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In: European Heart Journal. - : Oxford University Press. - 2048-8726 .- 2048-8734. ; 10:3, s. 287-301
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Abstract
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- Aims Troponin-based algorithms are made to identify myocardial infarctions (MIs) but adding either standard acute coronary syndrome (ACS) risk criteria or a clinical risk score may identify more patients eligible for early discharge and patients in need of urgent revascularization. Methods and results Post-hoc analysis of the WESTCOR study including 932 patients (mean 63years, 61% male) with suspected NSTE-ACS. Serum samples were collected at 0, 3, and 8-12h and high-sensitivity cTnT (Roche Diagnostics) and cTnI (Abbott Diagnostics) were analysed. The primary endpoint was MI, all-cause mortality, and unplanned revascularizations within 30days. Secondary endpoint was non-ST-elevation myocardial infarction (NSTEMI) during index hospitalization. Two combinations were compared: troponin-based algorithms (ESC 0/3h and the High-STEACS algorithm) and either ACS risk criteria recommended in the ESC guidelines, or one of eleven clinical risk scores, HEART, mHEART, CARE, GRACE, T-MACS, sT-MACS, TIMI, EDACS, sEDACS, Goldman, and Geleijnse-Sanchis. The prevalence of primary events was 21%. Patients ruled out for NSTEMI and regarded low risk of ACS according to ESC guidelines had 3.8-4.9% risk of an event, primarily unplanned revascularizations. Using HEART score instead of ACS risk criteria reduced the number of events to 2.2-2.7%, with maintained efficacy. The secondary endpoint was met by 13%. The troponin-based algorithms without evaluation of ACS risk missed three-index NSTEMIs with a negative predictive value (NPV) of 99.5% and 99.6%. Conclusion Combining ESC 0/3h or the High-STEACS algorithm with standardized clinical risk scores instead of ACS risk criteria halved the prevalence of rule-out patients in need of revascularization, with maintained efficacy.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Chest pain
- High-sensitivity troponin assay
- ESC 0/3h algorithm
- High-STEACS
- Risk score
- Revascularization
Publication and Content Type
- ref (subject category)
- art (subject category)
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Steiro, Ole-Thom ...
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Tjora, Hilde L.
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Langorgen, Jorun ...
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Bjorneklett, Run ...
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Nygård, Ottar K.
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Skadberg, Oyvind
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Bonarjee, Vernon ...
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Lindahl, Bertil, ...
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Omland, Torbjorn
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Vikenes, Kjell
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Aakre, Kristin M ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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European Heart J ...
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Uppsala University